(Original quote from Romeo & Juliet: “What’s in a name, that which we call a rose by any other name would still smell as sweet.” - Sporthrix is a fungal infection that causes subcutaneous mycosis and it is acquired through penetration of the skin by a rose thorn. I figured this quote would help some classmates remember this diagnosis because it was a cute little play on words). :)
On this rotation I worked with 3 amazing providers: Dr. Fulk mostly did cosmetic procedures including botox and fillers; Dr. Brimhall, a biochem wizard, was an absolute genius when it came to understanding skin on the microscopic level; and finally, there was Daniel, the physician assistant with whom I spent most of my time. I had the chance to work with all 3 great providers however long I wanted, but I chose to work with Daniel the most. Daniel challenged me to make diagnoses on my own more than the other providers and would also encourage me to ask pertinent questions to the patients to help rule in/out specific conditions. He was a great teacher!
I am so grateful for this rotation because one thing I've always wanted to be able to do is differentiate between normal skin lesions and malignant ones. I have noticed so many patients find themselves worried about their lesions even though their primary care provider has tried to reassure them they are fine. There are many lesions that can be difficult to diagnose: for example, there are small scaly growths called Seborrheic Keratoses which are benign, but can be very similar to Actinic Keratoses, which are a little more serious and are the precursors to Squamous Cell Carcinomas (skin cancer). Anyway, its just nice to know that I have seen over 200 of these lesions and will be better able to differentiate the two for my future patients.
I also had the opportunity to see some of the rarest conditions known to the medical field! My first week we saw a follow up case for the diagnosis of Leprosy; a couple weeks after that we saw Grover’s Disease, Disseminated Granuloma Annulare, Discoid Lupus, Guttate Psoriasis, and of course Sporotrichosis. There were also the really common diagnoses that I found myself making regularly like Bullous Pemphigoid, Pemphigus Vulgaris and Telogen Effluvium. It was awesome!
Fortunately, I am a visual learner and I feel like once I see something in real life, it's burned in my memory vs learning something that is simply read in a textbook. I am definitely satisfied with the amount of exposure I received on this rotation. One of the biggest takeaways is that I feel like I saw different presentations of the same conditions. Depending on a patients race or amount of sun exposure they had in their past, these factors can play a big role on how conditions present. This kind of experience is going to be key to recognizing and treating these tricky skin conditions in my future, can't wait!
Check out my last post for a few Derm based tips!